Exercise and Physical Activity for Knee Osteoarthritis
Understanding how to monitor pain and what exercises to do
Exercise and physical activity are recommended for all people with knee osteoarthritis regardless of age, pain levels, severity of the condition or co-morbidities.
Are exercise and physical activity good for osteoarthritis?
The cartilage in our joints love movement! Exercise can reduce pain and, over time, improve function to make daily tasks easier. It’s also good for your body and mind and can lead to lots of positive things like a strong heart and good overall health.
The benefits of exercise disappear when you stop exercising. To keep the effects of exercise, you have to keep exercising regularly. This is why it’s important to do exercises that you enjoy. This will help make exercise part of your daily routine. Examples of exercises that might work well are: walking, running, aquatic (water) exercises, dancing, cycling, and strength training.
What is the difference between exercise and physical activity?
Physical Activity
Physical activity is any bodily movement produced by the skeletal muscles that results in burning more energy compared to rest.
Examples of ways to be more physically active might be walking instead of driving, taking the stairs instead of the elevator.
Exercise
Exercise is a specific type of physical activity that is planned, structured, and aims to improve one or more components of fitness (e.g. strength, endurance, flexibility).
Examples of ways to increase your exercise may include going to a muscle strength class.
It is good to become more physically active with knee osteoarthritis (do more of the things you enjoy, such as gardening, shopping, cooking), whilst also supplementing this with regular structured exercise (such as running, walking, strengthening training). Being more physically active by doing things that you enjoy in your free time will keep you happy and improve your overall health. Being active can also help distract from the pain and, if weight is a factor, help you burn off more calories.
The World Health Organisation guidelines recommend the following for all people – with or without knee osteoarthritis to maximise overall health:
- A minimum of 150 minutes of moderate intensity aerobic physical activity or exercise per week (or broken down as 30 minutes per day across 5 days),
- A minimum of 2 strength training sessions per week,
- PLUS limit the amount of time doing sedentary activities like sitting.
Those aged 65 and above are recommended to do balance and strength training on 3 or more days a week, to improve physical function and to prevent falls.
If this seems off-putting, remember that every movement counts! Taking the stairs where you have an option, walking to the shops, gardening, parking a little bit further away from your destination will all help to improve your joint health and overall health.
Is exercise good for me, even if my knee hurts?
Research has found that exercise and physical activity has a positive effect on pain and function. Everybody reacts to pain differently. Pain is the main reason people with knee osteoarthritis seek treatment. It’s also the main reason people with knee osteoarthritis avoid exercise. People in pain sometimes avoid activity, but being less active can make your pain worse over time.
Inactivity causes muscle weakness, the knee might feel like it is going to “give way”, you can gain weight, and your mood and sleep problems can get worse. All of these things can make you avoid activity even more. It’s a vicious cycle.
It’s normal to feel a bit of pain when you start exercising. You may have a bit of muscle soreness if you haven’t used these muscles regularly or have some joint pain. The muscle soreness will decrease as you get used to exercising. It is important to decide the pain limits that are acceptable to you. These pain limits will be different for everyone and can change over time. Use the rules in the graphic provided here to help guide your exercise.
It’s important to listen to your body and strike a balance when exercising. Focus on your exercise goals to distract yourself from any pain. Don’t forget to have fun!
Is exercise good for me, even if my knee hurts?
Research has found that exercise and physical activity has a positive effect on pain and function. Everybody reacts to pain differently. Pain is the main reason people with knee osteoarthritis seek treatment. It’s also the main reason people with knee osteoarthritis avoid exercise. People in pain sometimes avoid activity, but being less active can make your pain worse over time.
Inactivity causes muscle weakness, the knee might feel like it is going to “give way”, you can gain weight, and your mood and sleep problems can get worse. All of these things can make you avoid activity even more. It’s a vicious cycle.
It’s normal to feel a bit of pain when you start exercising. You may have a bit of muscle soreness if you haven’t used these muscles regularly or have some joint pain. The muscle soreness will decrease as you get used to exercising. It is important to decide the pain limits that are acceptable to you. These pain limits will be different for everyone and can change over time. Use the rules in the graphic provided here to help guide your exercise.
It’s important to listen to your body and strike a balance when exercising. Focus on your exercise goals to distract yourself from any pain. Don’t forget to have fun!
What are the best exercises for osteoarthritis?
The best exercises for osteoarthritis are the ones that you will continue to do as part of your regular routine! In general, medical guidelines suggest that people with knee osteoarthritis should engage in:
Aerobic activity
Strength training
If you are starting from 0 minutes of activity a week, it is important to start slowly and gradually increase your time spent being active. A daily 10-minute walk is a great place to start. We have also provided some example exercises below that will help you strengthen the muscles around your joint.
Some people will need help or supervision with an exercise programme until they gain some confidence in their knee joint and their ability. A chartered physiotherapist will be able to provide you with a programme that can be home-based or done in a group setting with other people with osteoarthritis or chronic joint conditions.
The GLA:D Ireland programme (Good Life with osteoArthritis Denmark) is an example of a group exercise and education programme for hip and knee osteoarthritis that is led by physiotherapists and available in healthcare and community settings all around Ireland (and the world). Click here to see where GLA:D is available and how to get referred.
Knee Osteoarthritis Exercise Programme
Exercises that have been found to be helpful and can be performed at home are explained in the videos below. You can start at Level 1, 2 or 3. Each individual exercise is also described in the table below and accompanied by video links and downloadable files that you can print.
Monitoring your pain
Remember many people experience an increase in knee discomfort when performing exercises. Review the advice on monitoring knee pain during and after exercise above.
before you start
Seek advice from a healthcare professional before engaging in these exercises for the first time. Choose a safe and well-lit space to exercise. Hold on to a table or stable surface for balance if needed.
where to start
If you are new to exercise or your knee pain is very easily irritated, we would suggest starting at Level 1. It can take two or three weeks of repeating these exercises daily to build confidence and strength to progress to Level 2. When you’re comfortable with the exercises on Level 2 and they’ve become easier, you can progress to Level 3. Holding a light weight (2 or 3kg) can increase the challenge as you perform the Level 3 exercises.
how many exercises
The number of suggested repetitions for each exercise is something to aim for. Everyone will have a different starting point. If your starting point is just a few repetitions of each exercise, that’s fine. You could repeat that more than once a day. When you are able to perform more exercises together, we would suggest performing once a day or every other day.
what if I experience a setback?
Experiencing a setback or ‘flare up’ of jnee pain after starting a new exercise programme or activity can be normal. Stay calm, switch to easier exercises and use ice or pain medication until symptoms improve. If your pain does flare, you have not harmed or damaged your knee.
preparing to exercise
Warm up by walking or ‘marching on the spot’ for 3 to 4 minutes before you start your exercises. This will help your muscles prepare for the activity by increasing your circulation.
Level 1 Knee Osteoarthritis Exercise Programme
Level 2 Knee Osteoarthritis Exercise Programme
Level 3 Knee Osteoarthritis Exercise Programme
Lived Experience of Managing Knee Pain with Physical Activity
Can exercise and physical activity delay the need for a knee replacement?
YES!!!
Most people with knee osteoarthritis can improve their pain and function and reduce the need for surgery by engaging in exercise and physical activity. This is great as it is a cost-effective way to manage your symptoms.
Listen to Matthew and Patrick’s experiences of being physically active with knee osteoarthritis by playing the videos below.